More than 100,000 civilians, most women & children, have probably died in Iraq as direct or indirect consequences of the March 2003 U.S. invasion, according to a study by a research team at Johns Hopkins University.

More than 100,000 civilians have probably died in Iraq as direct or indirect consequences of the March 2003 U.S.-led invasion, according to a study by a research team at Johns Hopkins University’s Bloomberg School of Public Health in Baltimore.

The report was scheduled for publication on the Internet Friday by The Lancet, the English medical journal.

The figure is far higher than previous mortality estimates.

Editors of the journal decided not to wait for Lancet’s normal publication date next week, but instead to place the research online Friday, apparently so it could circulate before the U.S. presidential election.

The finding is certain to generate intense controversy, since the Bush administration has not estimated civilian casualties from the conflict, and independent groups have put the number at most in the tens of thousands.

In the study, teams of researchers fanned out across Iraq in mid-September to interview nearly 1,000 families in 33 previously selected locations. Families were interviewed about births and deaths in the household before and after the invasion.

Although the paper’s authors acknowledge that thorough data collection was difficult in what is effectively still a war zone, the data they managed to collect are extensive:

Iraqis were 2.5 times more likely to die in the 17 months following the invasion than in the 14 months before it. Before the invasion, the most common causes of death in Iraq were heart attacks, strokes and chronic diseases. Afterward, violent death was far ahead of all other causes.

“We were shocked at the magnitude but we’re quite sure that the estimate of 100,000 is a conservative estimate,” said Dr. Gilbert Burnham of the Johns Hopkins study team. He said the team excluded deaths in Falluja in making their estimate, since that city was the site of unusually intense violence.

In 15 of the 33 communities visited, residents reported violent deaths in the family since the conflict started. They attributed many of those deaths to attacks by coalition forces mostly airstrikes and most of those killed were women and children. The risk of violent death was 58 times higher than before the war, the researchers reported.

“The fact that more than half of the deaths caused by the occupation forces were women and children is a cause for concern,” the authors wrote.

The team, led by Dr. Les Roberts, included researchers from the Johns Hopkins Center for International Emergency, Disaster and Refugee Studies as well as doctors from al-Mustansiriya University Medical School in Baghdad.

There is bound to be skepticism about the estimate of 100,000 excess deaths, which translates into an average of 166 excess deaths a day since the invasion. But some were not surprised.

“I am emotionally shocked, but I have no trouble in believing that this many people have been killed,” said Scott Lipscomb, an associate professor atNorthwestern University, who works on a Web site called www.iraqbodycount.net. That project, which collates only media-reported deaths, currently put the maximum death toll at just under 17,000. “We’ve always maintained that the actual count must be much higher,” Lipscomb said.

The Lancet researchers were highly technical in their selection of interview sites and data analysis, although interview locations were limited somewhat by the researchers’ decision to cut down driving time when statistically possible to minimize risk to the interviewers.

Although the teams relied primarily on interviews with local residents, they also requested to see at least two death certificates at the end of interviews in each area, to try to ensure that people had remembered and responded honestly. The research team decided that asking for death certificates in each case, during the interviews, might cause hostility and could put the research team in danger.

Some of those killed may have been insurgents, not true civilians, the authors noted. Also, the rise in mortality included a rise in murders and some deaths attributable to the deterioration of medical care. “But the majority of excess mortality is clearly due to violence,” Burnham said.

The paper is studied and scientific, reserving judgment on the politics of the Iraq conflict. But in an accompanying editorial, Richard Horton, editor of The Lancet, is acerbic and to the point about its message. The paper was received in October, but it was peer-reviewed and edited at top speed because of its political importance.

“From a purely public health perspective it is clear that whatever planning did take place was grievously in error,” Horton wrote. “The invasion of Iraq, the displacement of a cruel dictator and the attempt to impose a liberal democracy by force have, by themselves, been insufficient to bring peace and security to the civilian population. Democratic imperialism has led to more deaths, not fewer.”

In their paper, Roberts and his colleagues are extremely critical of the Bush administration and the U.S. Army for not releasing estimates of civilian deaths.

“This study shows that with moderate funds, 4 weeks, and 7 Iraqi team members willing to risk their lives, a useful measure of civilian deaths could be obtained,” the authors wrote. International Herald Tribune

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